Presentation
Bilateral mastalgia.
Patient Data
A firm, well circumscribed and mobile lesion of 2 cm is palpable in the retroareolar region of the left breast of a 35 years old patient. No axillary lymphadenopathy are observed.
The lump is noticed for 10 years.
The ultrasound images, performed 10 years ago, showed a round homogeneous hypoechoic mass of 1 cm, and at that time the diagnosis of a breast fibroadenoma was made.
The patient no longer made ultrasounds or clinical examinations.
She came to visit for bilateral mastalgia.
The latest ultrasound shows a lobulated solid and cystic lesion with well defined margins and posterior acoustic enhancement.
Solid-cyst breast mass.
Case Discussion
The mixed and vascular pattern of the lesion points to a diagnosis of phyllodes tumor and indicate surgical excision.
Mammography is not performed for the young age of the patient and for the benign aspect of the lesion; similarly, core biopsy or FNAC was not performed because the lesion shows a benign aspect but the working diagnosis suggests its surgical excision.
Wide surgical excision is performed and the final histopathology report confirms the diagnosis of benign phyllodes tumor.
Conclusion
On breast ultrasound, the sonographic characteristics between fibroadenoma and phyllodes tumors are commonly overlapping; but the heterogeneous pattern (or the presence of cystic spaces inside a hypoechoic lesion) and the vascular pattern can be helpful to suggest the diagnosis of phyllodes tumor.